The effects of selenium supplementation on clinical outcomes in mechanically ventilated, non-surgical/traumatic critically ill patients

Background: Selenium presents anti-inflammatory and antioxidant properties which plays a critical role in nutrition of patients following devastating conditions. Furthermore, several lines of evidence reported that most of patients who admitted to intensive care unit (ICU) have lower plasma levels of selenium. Therefore, this study was designed to define the impact of selenium supplementation on clinical outcomes of mechanically ventilated non-surgical/traumatic critically ill patients.Materials and Methods: This study was conducted on 105 subjects hospitalized in ICU of Shohadaye Haft-e Tir Hospital, Tehran, Iran. Here the acute physiologic assessment and chronic health evaluation (APACHE) II score of patients was documented on the day of their ICU admission. The patients were divided to two groups based on block randomization technique and were assigned to receive selenium or placebo. Then the effect of selenium supplementation was evaluated based on the APACHE II score, the occurrence of ventilator associated pneumonia (VAP), length of ICU stay and the rate of mortality.Results: The acquired data revealed no significant difference between two experimental groups based on the demographical information. Also it was demonstrated that selenium supplementation of critically ill patients was associated with better APACHE II score, fewer length of ICU stay and fewer mortality rate. Incidence of VAP indicated no significant difference between groups.Conclusion: The obtained data of this single center clinical trial showed that selenium supplementation could improve clinical outcomes of critically ill patients.Keywords: Selenium supplementation; APACHE II score; ventilator associated pneumonia; mortality rate; length of ICU sta

Deep Vein Thrombosis among Intensive Care Unit Patients; an Epidemiologic Study

Introduction: Deep vein thrombosis (DVT) is a major cause of morbidity and mortality in intensive care unit (ICU) patients despite use of prophylactic anticoagulant therapy. The aim of the present study was to determine the incidence of DVT among medical and surgical ICU patients.Methods: In this cross sectional study, patients older than 18 years who were hospitalized in the ICU of Imam Hossein educational Hospital, Tehran, Iran, for ≥ 2 days, during August 2008 to July 2011 were evaluated regarding DVT incidence. Demographic data, comorbidities, acute physiology and chronic health evaluation (APACHE) II scores, ICU length of stay, type of DVT prophylaxis, and patient outcomes were analyzed using SPSS 19.Results: Out of the 1387 reviewed patient files, 500 (36.04%) patients had been classified as potential DVT cases. DVT occurred in 3.5% of them with the mean age of 60 ± 18 years (62.5% male) and mortality rate of 27.1%. Significant independent risk factors of DVT incidence were age (p = 0.02) and length of ICU stay (p = 0.01).Conclusion: The results of this study showed the 3.5% incidence of DVT in ICU admitted patients. Longer ICU stay and older age were independent risk factors of DVT development

Familiarity of Physicians and Nurses with Different Aspects of Oxygen Therapy; a Brief Report

Introduction: Oxygen is a drug and physician and nurses should be familiar with the effects and potential risks of oxygen therapy. The current study aimed to assess familiarity of physicians and nurses with various aspects of oxygen therapy.Method: In this cross sectional study, the familiarity of physicians and nurses with various aspects of oxygen therapy in a teaching hospital was evaluated using a validated questionnaire. The collected data were analyzed using SPSS 21 software.Results: 57 physicians and 79 nurses returned the completed questionnaire (response rate 97.1%). Mean clinical work experience of participants was 6.9±5.7 (1–15) years.98.2% of physicians believed that oxygen therapy can be associated with risk and should be recorded in the patient's medical file. These measures were 92.4% and 98.2% for nurses. 38 (27.9%) participants correctly pointed out the reasons for oxygen therapy. Regarding necessary measurements and monitoring for oxygen therapy, 49 (86%) physicians and 65 (82.3%) nurses chose the correct answer. In addition, regarding necessity of blood gas analysis during oxygen therapy, 44 (77.2%) physicians and 55 (69.6%) nurses chose the correct answer.Conclusion: The findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indications, necessary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%)

Biochemical Markers in Neurocritical Care

During the past two decades, a variety of serum or cerebrospinal fluid (CSF) biochemical markers in daily clinical practice have been recommended to diagnose and monitor diverse diseases or pathologic situations. It will be essential to develop a panel of biomarkers, to be suitable for evaluation of treatment efficacy, representing distinct phases of injury and recovery and consider the temporal profile of those. Among the possible and different biochemical markers, S100b appeared to fulfill many of optimized criteria of an ideal marker. S100b, a cytosolic low molecular weight dimeric calciumbinding protein from chromosome 21, synthesized in glial cells throughout the CNS, an homodimeric diffusible, belongs to a family of closely related protein, predominantly expressed by astrocytes and Schwann cells and a classic immunohistochemical marker for these cells, is implicated in brain development and neurophysiology. Of the 3 isoforms of S-100, the BB subunit (S100B) is present in high concentrations in central and peripheral glial and Schwann cells, Langerhans and anterior pituitary cells, fat, muscle, and bone marrow tissues. The biomarker has shown to be a sensitive marker of clinical and subclinical cerebral damage, such as stroke, traumatic brain injury, and spinal cord injury. Increasing evidence suggests that the biomarker plays a double function as an intracellular regulator and an extracellular signal of the CNS. S100b is found in the cytoplasm in a soluble form and also is associated with intracellular membranes, centrosomes, microtubules, and type III intermediate filaments. Their genomic organization now is known, and many of their target proteins have been identified, although the mechanisms of regulating S100b secretion are not completely understood and appear to be related to many factors, such as the proinflammatory cytokines, tumor necrosis factor alpha (TNF-a), interleukin (IL)-1b, and metabolic stress.

Dexmedetomidine in Neurocritical Care

Early and appropriate management of brain insults has significantly reduced patient morbidity and mortality. Neuromonitoring, neuroprotection and secondary brain injury prevention are the essential principals of brain injury management. In this literature review we have elaborated the neuroprotective role of dexmedetomidine (DEX), predominantly in different animal models of brain insults and reports in patients cared in a neurocritical care setting.  We undertook an electronic literature search of articles published in English prior to July 2019. This search resulted in inclusion of 59 studies from medical databanks such as PubMed, Scopus, EMBSCO, CINAHL, ISC and the Cochrane Library. The keywords used were brain, α2 agonist, neurocritical care and dexmedetomidine. DEX may have a neuroprotective effect in a broad spectrum of brain pathologies such as traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), ischemic stroke, intracerebral hemorrhage (ICH), and cerebral hypoxia. However, its neuroprotective role in status epilepticus (SE) is less clear. Further animal and human studies are needed before we could consider DEX as a neuroprotective agent in this patient population. Due to its favorable properties outlined in this review, DEX could be considered a favorable sedative agent in the neurocritical care settings

Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation

سابقه و هدف: واحد مراقبت‌های ویژه مغز و اعصاب به مراقبت از بیماران دچار شرایط بحرانی و تهدید کننده حیات در زمینه بیماری های مغز و اعصاب اختصاص دارد و از آنجایی‌که با محدودیت منابع جهت افزایش تخت های مراقبت های ویژه و همچنین افزایش زمان انتظار بیماران در این بخش رو به رو می باشیم نیازمند دستیابی به بهینه ترین ترکیب ممکن برای تخصیص تخت ها به هر نوع از بیماران و تعداد تخت در بخش مراقبت های ویژه می باشیم. لذا در این مطالعه برای استفاده بهینه از تخت ها و نیز به منظور کاهش متوسط زمان انتظار بیماران در بخش مراقبت‌های ویژه مغز و اعصاب مرکز پزشکی، آموزشی درمانی لقمان حکیم وابسته به دانشگاه علوم پزشکی شهید بهشتی به شبیه سازی بخش مورد نظر پرداخته تا ترکیب بهینه تخت های موجود در این بخش حاصل شود. روش بررسی: در این مطالعه ابتدا ترکیب تخصیص تخت های بخش مراقبت های ویژه مغز و اعصاب بیمارستان لقمان حکیم به هر دسته از بیماری ها مشخص شد و با استفاده از نرم افزار طراحی آزمایشات بهینه ترین ترکیب های ممکن بدست آمد. سپس ترکیب های بدست آمده شبیه سازی شده و دو معیار میانگین زمان انتظار در صف برای بیماران و میزان بهره وری (اشغال تخت) برای هر یک از ترکیب ها محاسبه شد. پس از آن مدل ریاضی شامل اهداف کمینه سازی متوسط ​​زمان انتظار بیماران در صف و همچنین میانگین بهره وری تخت ها با استفاده از روش پاسخ خطی ارائه شد. نتایج: بر اساس نتایج، تعداد بهینه انواع تخت های مورد استفاده در این بخش به ترتیب برابر با شش، دو، سه، سه و دو تخت برآورد شدند که منجر به متوسط زمان انتظار 1.4 ساعتی بیماران و نیز متوسط بهره وری 34.5 درصدی مجموع تخت ها شد. نتیجه‌گیری: نتایج مطالعه حاضر بیانگر این واقعیت است که بهینه سازی تخصیص تخت در بخش مراقبت‌های ویژه مغز و اعصاب با بکارگیری رویکرد ترکیبی شبیه سازی و طراحی آزمایشات ، باعث کاهش متوسط زمان انتظار بیماران و به تبع آن افزایش بهره وری (درصد اشتغال به کار) تخت ها می شود. How to cite this article: Goharani R, Shafagh-sorkh O, Nateghinia S, Hajiesmaeili M, Alibabaei A, Shafigh N. Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation. J Saf Promot Inj Prev. 2021; 9(1):9-17.Background & Objectives: Neurological Critical Care Unit is allocated for patients with critical conditions in the field of neurological diseases. ICU beds and their equipment are very expensive and there are some economic constraints for increasing the ICU beds. At the same time, the admission waiting time for patients in this unit is not favorable. Therefore, an initiative for better management of this ward was needed.  The objective of this study was to examine an optimal program for allocating beds to patients, based on their required length of stay in the unit. Methods and Materials: In this study, different categories of patients and their quantity was investigated in the Loghman Hakim hospital. Then, by using the design of experiments technique, optimal combinations were obtained. The obtained combinations were simulated for each of two criteria was calculated; patients' average waiting time and bed occupancy rate. Subsequently, a mathematical model with the objective function of minimizing the average waiting time for patients, as well as the average bed occupancy rate was presented using the linear response method. Results: According to the results of this study, an optimal combination of beds allocation to different categories of patients for the Neurological Critical Care Unit were respectively 6, 2, 3, 3, and 2 beds, and average waiting time was 1.4 hours and an average bed occupancy rate was 34.5%. Conclusion: The present study demonstrated that optimization of bed allocation in ICU by using a combined approach of simulation and design of experiments, resulted in a decrease in average waiting time and increase in bed occupancy rate (bed productivity). How to cite this article: Goharani R, Shafagh-sorkh O, Nateghinia S, Hajiesmaeili M, Alibabaei A, Shafigh N. Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation. J Saf Promot Inj Prev. 2021; 9(1):9-17. &nbsp

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Objective: To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/ fraction of inspired oxygen (Fi O2) and partial pressure of alveolar oxygen (PAO2)/Fi O2 may be used as effective surrogates for the partial pressure of arterial oxygen (PaO2)/Fi O2. Also, to determine the SpO2/Fi O2 and PAO2/Fi O2 values that correspond to PaO2/Fi O2 thresholds for identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery. Methods: A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2, PAO2, SaO2, and Fi O2. Linear regression modeling was used to quantify the relationship between indices. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values. Results: One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validation cohort. The SPO2/Fi O2 and PAO2/Fi O2 ratios could be predicted well from PaO2/Fi O2, described by the linear regression models SPO2/Fi O2 = 71.149 + 0.8PF and PAO2/Fi O2 = 38.098 + 2.312PF, respectively. According to the linear regression equation, a PaO2/Fi O2 ratio of 300 equaled an SPO2/Fi O2 ratio of 311 (R2 0.857, F 1035.742, < 0.0001) and a PAO2/Fi O2 ratio of 732 (R2 0.576, F 234.887, < 0.0001). The SPO2/Fi O2 threshold of 311 had 90% sensitivity, 80% specificity, LR+ 4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/Fi O2 threshold of 732 had 86% sensitivity, 90% specificity, LR+ 8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/ Fi O2 had excellent discrimination ability for mild ARDS (AUC ± SE = 0.92 ± 0.017; 95% CI 0.889 to 0.947) as did PAO2/ Fi O2 (AUC ± SE = 0.915 ± 0.018; 95% CI 0.881 to0.942). Conclusions: PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/Fi O2 of 300 correlating to an SPO2/ Fi O2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ Fi O2 ratio may allow for early real-time rapid identification of ARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated with serial arterial blood gas measurements

A Comparative Study of High-Dose Colistin Administration for the Management of Multidrug-Resistant Gram-Negative Infections in the ICU

The aim of this study was to assess the clinical and microbiological efficacy and toxicity of different high-dose regimens of colistin in the ICU patients with colistin-sensitive MDR Gram-negative infections. In this prospective, open label, randomized clinical trial, patients with clinical features of infection and positive culture for MDR colistin-sensitive Gram-negative bacteria were randomly allocated to receive colistin, 3 or 9 million units every 8 and 24 hours, (groups A and B), respectively. For each dose regimen, clinical and microbiological response, the rates of nephrotoxicity, and its risk factors were analyzed. Forty-three patients were enrolled, and 35 completed the study protocol, of whom 30 (88.2%) had ventilator-associated pneumonia (VAP) and 5 (14%) had bacteremia. Although there were no statistically significant differences in the clinical or microbiological response between the study groups, the microbiological response favored the divided dose group numerically (p=0.40). Clinical response was achieved in 27 of 35 (77.1%) patients (p=0.999). Twelve (34.28%) patients developed AKI during colistin treatment, 4 and 8 in groups A and B, respectively (p value =0.193). Significant risk factors for nephrotoxicity related to colistin were age, hyperbilirubinemia, and coadministration of other nephrotoxic agents. In multivariate regression analysis, the only independent risk factor for CMS-associated AKI was hyperbilirubinemia (p value =0.008). Although the clinical and microbiological responses to colistin administration were not statistically different in two groups, the microbiological response favored the divided dose regimen group numerically. We did not observe any significant safety concerns with high-dose colistin administration in this population

Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

Abstract Objective To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA). Methods We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical--surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angelâ„¢ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge. Results One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P-‰&lt;-‰0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P-‰&lt;-‰0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones. Conclusion Use of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge. Trial registration The study was registered with Clinicaltrials.gov ( NCT02845011 ), registered retrospectively on July 21, 2016